Tuesday, December 28, 2010

From the New York Times article "Unearthing Prehistoric Tumors, and Debate":

Often thought of as a modern disease, cancer has always been with us. Where scientists disagree is on how much it has been amplified by the sweet and bitter fruits of civilization. Over the decades archaeologists have made about 200 possible cancer sightings dating to prehistoric times. But considering the difficulties of extracting statistics from old bones, is that a little or a lot?
...
As scientists continue to investigate, there may be comfort in knowing that cancer is not entirely civilization’s fault. In the normal course of life a creature’s cells must be constantly dividing — millions of times a second. Sometimes something will go wrong.

Saturday, December 25, 2010

From the Plos One article "Placebos without Deception: A Randomized Controlled Trial in Irritable Bowel Syndrome":

Placebos administered without deception may be an effective treatment for IBS. Further research is warranted in IBS, and perhaps other conditions, to elucidate whether physicians can benefit patients using placebos consistent with informed consent.

Monday, December 06, 2010

From the New York Times article "Doctor Faces Suits Over Cardiac Stents":

The Senate Finance Committee, which oversees Medicare, started investigating Dr. Midei in February after a series of articles in The Baltimore Sun said that Dr. Midei at St. Joseph Medical Center, in Towson, Md., had inserted stents in patients who did not need them, reaping high reimbursements from Medicare and private insurance.

The senators solicited 10,000 documents from Abbott and St. Joseph. Their report, provided in advance to The New York Times, concludes that Dr. Midei “may have implanted 585 stents which were medically unnecessary” from 2007 to 2009. Medicare paid $3.8 million of the $6.6 million charged for those procedures.

Sunday, November 21, 2010

Yep, definitely nepotism, but I wanted to let "my world" know about the new blog started by my nephew Erik's wife, Meadow. Both Erik and Meadow are art teachers at Watts Atelier in the beach community of Encinitas, California -- both also freelance. Meadow actually makes the period costumes for her paintings...her first blog posting is about how she is making a regency bonnet for a client...click here to check it out!. Click here to see some of her paintings. And, if you're missing Halloween, check out Erik's blog and his website (not for the faint of heart!). Yes, I suppose my posting these links on my blog will be considered a "conflict of interest"...no resolution needed, however.

Monday, November 08, 2010

CareFirst BlueCross BlueShield (CareFirst) today announced that, effective immediately, it will permit nurse practitioners (NPs) to participate in its health care provider networks as independent primary care providers. Previously, CareFirst permitted NPs to participate in its networks, but they were only permitted to practice independently of physicians in certain medically underserved areas with limited access to primary care physicians.

The North American Association of Medical Education and Communication Companies (NAAMECC) recently changed its name to the National Association of Medical Education Companies (NAMEC). Click here to access their website.

Sunday, October 17, 2010

From the New York Times article "Physician Revives a Dying Art: The Physical":

He is out to save the physical exam because it seems to be wasting away, he says, in an era of CT, ultrasound, M.R.I., countless lab tests and doctor visits that whip by like speed dates. Who has not felt slighted by a stethoscope applied through the shirt, or a millisecond peek into the throat?

Some doctors would gladly let the exam go, claiming that much of it has been rendered obsolete by technology and that there are better ways to spend their time with patients. Some admit they do the exam almost as a token gesture, only because patients expect it.

Medical schools in the United States have let the exam slide, Dr. Verghese says, noting that over time he has encountered more and more interns and residents who do not know how to test a patient’s reflexes or palpate a spleen.

Click here to access the NYT article. As my stepfather, who was a large animal veterinarian, always taught me...H&P, H&P, H&P!

Sunday, October 03, 2010

FOR decades, antipsychotic drugs were a niche product. Today, they’re the top-selling class of pharmaceuticals in America, generating annual revenue of about $14.6 billion and surpassing sales of even blockbusters like heart-protective statins.
...
Anointed with names like Abilify and Geodon, the drugs were given to a broad swath of patients, from preschoolers to octogenarians. Today, more than a half-million youths take antipsychotic drugs, and fully one-quarter of nursing-home residents have used them. Yet recent government warnings say the drugs may be fatal to some older patients and have unknown effects on children.
...
Such marketing, according to analysts and court documents, included payments, gifts, meals and trips for doctors, biased studies, ghostwritten medical journal articles, promotional conference appearances, and payments for postgraduate medical education that encourages a pro-drug outlook among doctors. All of these are tools that federal investigators say companies have used to exaggerate benefits, play down risks and promote off-label uses, meaning those the F.D.A. hasn’t approved.
...
Over the next year, the government is adding at least 15 prosecutors and 100 investigators to pursue health care fraud.

Sunday, September 26, 2010

From the New York Times article "Mammograms' Value in Cancer Fight at Issue":

Starting in their 40s or 50s, most women in this country faithfully get a mammogram every year, as recommended by health officials. But the study suggests that the decision about whether to have the screening test may now be a close call.
...
Previous studies of mammograms, done decades ago, found they reduced the breast cancer death rate by 15 to 25 percent, a meaningful amount. But that was when treatment was much less effective.
...
The study, published Thursday in The New England Journal of Medicine, looked at what happened in Norway before and after 1996, when the country began rolling out mammograms for women ages 50 to 69 along with special breast cancer teams to treat all women with breast cancer.

Saturday, September 04, 2010

Over the last 10 years, the percentage of Americans who took at least one prescription drug in the past month increased from 44% to 48%. The use of two or more drugs increased from 25% to 31%. The use of five or more drugs increased from 6% to 11%.

In 2007–2008, 1 out of every 5 children and 9 out of 10 older Americans reported using at least one prescription drug in the past month.

Those who were without a regular place for health care, health insurance, or prescription drug benefit had less prescription drug use compared with those who had these benefits.

The most commonly used types of drugs included: asthma medicines for children, central nervous system stimulants for adolescents, antidepressants for middle-aged adults, and cholesterol lowering drugs for older Americans.

Click here to access the report. Click here to access Pharmalot's take on this report.

Friday, September 03, 2010

A new study on the quality of physician care provides evidence of the benefit of specialty board certification and suggests the necessity of continuous professional development programs, such as the American Board of Medical Specialties Maintenance of Certification® (ABMS MOC®) program.
...
The study also found two other important quality distinctions relevant to the general population of physicians in the United States:

•Specialty board certification was associated with lower mortality and shorter stays.
•Physician performance declined over time, with mortality rates and length of stays increasing with the number of years since graduation from medical school. The study was authored by John Norcini, CEO of Foundation for Advancement of International Medical Education and Research, a Philadelphia-based not-for-profit.

Click here to access the ABMS news release. Click here to access the Health Affairs article published on the aforementioned study (subscription required).

Friday, August 20, 2010

Despite the best efforts of health care professionals, bad things can happen in hospitals. Up until more recently, when errors occurred, the scenario that played out was always the same. Clinicians, devastated but fearful of litigation, would shut down. Patients and their families, grieving but desperate to make sense of the event, would find that their doctors and nurses were no longer responsive or available. Eventually, the most important relationship in health care, that between patient and doctor, would cede to the most adversarial one, that between plaintiff and defendant.
...
“Everybody worries that disclosure will lead to liability going through the roof,” said Dr. Allen Kachalia, lead author and an assistant professor of medicine at Harvard Medical School. “But here’s one institution that set up their disclosure program privately and independently, helped their patients avoid using the courts and tort system, and did not sustain the skyrocketing claims and costs that others might have predicted.”

Click here to access Dr. Chen's column. Click here to access "Liability Claims and Costs Before and After Implementation of a Medical Error Disclosure Program" (abstract) in the Annals of Internal Medicine.

Monday, July 26, 2010

From the abstract of the Pediatrics journal article "Errors of Diagnosis in Pediatric Practice: A Multisite Survey":

The overall response rate was 53% (N = 726). More than one-half (54%) of respondents reported that RESULTS The overall response rate was 53% (N = 726). More than one-half (54%) of respondents reported that they made a diagnostic error at least once or twice per month; this frequency was markedly higher (77%) among trainees. Almost one-half (45%) of respondents reported diagnostic errors that harmed patients at least once or twice per year. Failure to gather information through history, physical examination, or chart review was the most-commonly reported process breakdown, whereas inadequate care coordination and teamwork was the most-commonly reported system factor. Viral illnesses being diagnosed as bacterial illnesses was the most-commonly reported diagnostic error, followed by misdiagnosis of medication side effects, psychiatric disorders, and appendicitis. Physicians ranked access to electronic health records and close follow-up of patients as strategies most likely to be effective in preventing diagnostic errors.

CONCLUSION Pediatricians reported making diagnostic errors relatively frequently, and patient harm from these errors was not uncommon.

Sunday, July 25, 2010

Perhaps the only consistent thing about Britain's socialized health care system is that it is in a perpetual state of flux, its structure constantly changing as governments search for the elusive formula that will deliver the best care for the cheapest price while costs and demand escalate.

Even as the new coalition government said it would make enormous cuts in the public sector, it initially promised to leave health care alone. But in one of its most surprising moves so far, it has done the opposite, proposing what would be the most radical reorganization of the National HealthService, as the system is called, since its inception in 1948.

Monday, July 19, 2010

Compared to two years ago, primary care physicians (PCPs) and specialist doctors alike have dramatically increased their use of electronic health records (EHRs), and they are expecting to spend less time with sales reps in the coming six months.

The study of nearly 11,000 health care professionals also shows that more than half of PCPs and specialists already have smartphones, and that many are using them for email, shopping, e-detailing – and survey taking.

Sunday, July 18, 2010

The suspension of some research at a prominent Columbia University brain-imaging lab because of sloppy practices could have repercussions beyond that laboratory, potentially affecting brain-imaging studies nationwide and raising questions about the safety of participants, research experts said Saturday.

Thursday, July 15, 2010

“The non-medical use of prescription pain-relievers is now the second most prevalent form of illicit drug use in the nation, and its tragic consequences are seen in substance abuse treatment centers and hospital emergency departments throughout our nation” said SAMHSA Administrator Pamela S. Hyde, J.D. “This public health threat demands that we follow the President’s National Drug Control Strategy’s call for an all out effort to raise awareness of this risk and the critical importance of properly using, storing, and disposing of these powerful drugs.”

Tuesday, July 13, 2010

The federal government issued new rules Tuesday that will reward doctors and hospitals for the “meaningful use” of electronic health records, a top goal of President Obama.

The rules significantly scale back proposed requirements that the health care industry had denounced as unrealistic.
...
Standards in the new rules are less demanding and more flexible. Doctors will have to meet 15 specific requirements, plus 5 chosen from a list of 10 objectives. Hospitals will have to meet 14 requirements, plus 5 chosen from a menu of 10 goals.
...
To meet the new standards, doctors will have to transmit 40 percent of electronically. Under the proposal, 75 percent of prescriptions had to be sent electronically. prescriptions

Reversing course on a new law aimed at diminishing the influence ondoctors of pharmaceutical and medical device companies, the House on Wednesday voted to strike the so-called gift ban law, which critics say has hurt commerce in the medical and restaurant industries.

It will be interesting to see what happens during the reconciliation process that needs to take place in committee! Click here to access this article.

President Barack Obama bypassed the Senate Wednesday and appointed Dr. Donald Berwick, a Harvard professor and patient care specialist, to run Medicare and Medicaid.
...
Medicare has been without an administrator since 2006, and the White House says the need to fill the post is critical because of its role in implementing the new health care law. Medicare is to be a key testing ground for numerous aspects of the new law, from developing new medical techniques to trying out new payment systems, and the White House says a permanent leader is key with deadlines approaching.

Berwick has praised Britain's National Health Service, and he told an interviewer last year: "The decision is not whether or not we will ration care -- the decision is whether we will ration with our eyes open. And right now, we are doing it blindly." He has also said that "any health-care funding plan that is just, equitable, civilized and humane must -- must -- redistribute wealth from the richer among us to the poorest and less fortunate.''

Monday, July 05, 2010

It’s not just that hospitals, doctors’ offices, clinics and other health facilities generate several billion pounds of garbage each year: buried in that mountain of trash are untold numbers of unused disposable medical devices as well as used but recyclable supplies and equipment, from excess syringes and gauze to surgical instruments.

The problem, fueled by a shift toward the use of disposables that made it simple to keep treatment practices sterile, has been an open secret for years, but getting the health care industry to change its habits has not been easy.

Friday, June 25, 2010

The results of a survey on physician attitudes about the marketing practices of industry has just been published in the Archives of Surgery and might provide some insight. Click here to access the article (free full text!). Hat tip to FierceHealthcare.

...first-year residents would be more closely supervised by experienced doctors, and the maximum length of their work shifts would be cut from 24 hours to 16 hours. In addition, all residents and their supervisors would be required to explain their roles to patients, making it clear that supervisors are ultimately in charge of their care.

PharmedOut is at this very moment conducting their conference "Prescription for Conflict: Should Industry Fund Continuing Medical Education?". Click here to access the conference agenda. Click here to read Policy and Medicine's blog posting on this conference.

Thursday, June 24, 2010

Dr. James O. Woolliscroft, dean of Michigan’s medical school, said leading faculty members “wanted education to be free from bias, to be based on the best evidence and a balanced view of the topic under discussion.”
...
The debate over whether the medical profession should develop an industry-free model of postgraduate education is a delicate one. A conference at Georgetown University on Friday, called “Prescription for Conflict,” will highlight the arguments on both sides through presentations by federal health officials, professors from leading medical schools, hospital executives and a Senate investigator.

Tuesday, June 22, 2010

From the JAMA article "Adherence to Surgical Care Improvement Project Measures and the Association With Postoperative Infections":

Our results are consistent with previous findings regardingpublic report of process-of-care quality data. Based on ourfindings, the individual item performance rates reported publiclydo not fulfill their stated purpose of pointing consumers towardhigh-quality hospitals. However, when taken in aggregate, improvedperformance on our global all-or-none composite measure is associatedwith improved outcomes at the discharge level. Therefore, whilethe individual items may not imply quality differences, theoverall ability to demonstrate adherence to multiple SCIP processesof care may. Improved methods for identification of qualityof care are necessary to be able to define improvements in patientoutcomes, and to justify the massive investment of time andmoney in tracking these processes of care.

Saturday, June 19, 2010

From the New York Times article "Surgeon vs. Knee Maker: Who's Rejecting Whom?:

IT was a long, fruitful medical marriage that is fast becoming an angry public divorce, one that offers a rare look at a clash between a top-shelf consultant and his corporate patron over patient safety.
...
Amid the booming use of artificial joints in the United States, the breakup between Dr. Berger and Zimmer highlights what experts say is a troubling situation for patients and doctors: when disputes arise about orthopedic implant safety, there are no independent referees or sources of information because no one tracks the performance of the devices.

Thursday, June 17, 2010

Emergency department visits involving the nonmedical use of pain drugs such as oxycodone rose to 305,885 in 2008, from 144,644 in 2004, according to a study by the Substance Abuse and Mental Health Services Administration and the Centers for Disease Control and Prevention.

"We urgently need to take action," CDC Director Dr. Thomas Frieden said in a statement, noting that trips to the emergency department for nonmedical use of prescription pain drugs are now as common as those for use of illicit drugs.

Monday, June 14, 2010

Is U.S. Rep. Edolphus Towns the new Big Pharma watchdog? The chair of the House Committee on Oversight and Government Reform is already spearheading an investigation into Johnson & Johnson's recent consumer-drug recalls. And now, he's launched a probe into Wyeth's marketing of the transplant drug Rapamune.

Sunday, June 13, 2010

Nonsmokers exposed to secondhand smoke were 1.5 times as likely to suffer from symptoms of psychological distress as unexposed nonsmokers, the study found, and the risk increases the greater their exposure to passive smoking.

Click here to access the NYT article. Click here to access the Archives of General Psychiatry article (free text).

Wednesday, June 09, 2010

Tri-City Medical Center's chief executive said Monday that he intends to fire five employees, and discipline a sixth, who allegedly discussed patient information on an Internet site.

In a statement released by the hospital, CEO Larry Anderson said Tri-City will pursue termination hearings for the five employees who "used social media to post their personal discussions concerning hospital patients."

Tri-City has not specified what kind of patient information was posted online, but Anderson said no patient names, photographs or similar identifying information appear to have been used.

Click here to access the NCT article. In this age of social media, this is one to follow!

Thursday, May 13, 2010

Interesting study published in the April 26, 2010 issue of the Archives of Internal Medicine entitled "Association of Interruptions With an Increased Risk and Severity of Medication Administration Errors". From the abstract:

Each interruption was associated with a 12.1%increase in procedural failures and a 12.7% increase in clinicalerrors. The association between interruptions and clinical errorswas independent of hospital and nurse characteristics. Interruptionsoccurred in 53.1% of administrations (95% confidence interval[CI], 51.6%-54.6%).

Wednesday, May 12, 2010

The FDA just launched the Truthful Prescription Drug Advertising and Promotion (Bad Ad Program). From the Reuters online article:

U.S. health officials are encouraging physicians to report misleading promotions from pharmaceutical salespeople who pitch medicines in doctors' offices or over dinner. The effort announced on Tuesday aims to increase regulators' reach into the largest area of prescription drug promotion -- the private contacts between drug company salespeople and prescribers.
...Starting this month, FDA staff will set up booths at major medical conferences to tell doctors how to spot questionable pitches. The agency also is sending a letter to about 33,000 healthcare providers about the campaign, dubbed the Bad Ad Program.

Apparently the idea for this campaign came from two former drug pitchmen. Click here to access the Reuters article. Click here to access the FDA news release.

Thursday, May 06, 2010

For the study, researchers at Brigham and Women's Hospital compared the administration of medications before and after bar codes were added to the hospital's electronic health record system (Reinberg, HealthDay/Businessweek, 5/5).
The researchers found that after bar code technology was added to EHRs, patients were:

57% less likely to receive the wrong drug;

42% less likely to receive the wrong dose;

61% less likely to receive a drug when none had been prescribed; and

27% less likely to receive a drug at the wrong time.

Click here to access the iHealthBeat.com article. Click here to access the NEJM article on this study.

Tuesday, May 04, 2010

At first glance, Hartford, Salt Lake City and Denver might not seem to have much in common. But a new survey by the American Academy of Dermatology (Academy) found these three cities outshine other U.S. cities in heeding dermatologists' advice on preventing and detecting skin cancer.

The “Suntelligence: How Sun Smart is Your City?” online survey polled more than 7,000 adults nationwide to determine their knowledge, attitudes and behaviors toward tanning, sun protection and skin cancer detection. Twenty-six cities were ranked based on respondents’ answers to several questions in each category.

Patients most likely affected by defensive medicine are 1) those requiring surgery, 2) women and 3) those visiting emergency rooms.

Defensive medicine is now being taught as standard medical practice. The survey found that 87 percent of current residents and fellows reported being taught to avoid lawsuits, compared with 48 percent of total respondents.

Click here to access add'l information on this survey as well as other surveys conducted by Jackson Healthcare.

Friday, April 30, 2010

Health Affairs has just published a great article on the administrative burden of billing for health care. From the article abstract:

The U.S. system of billing third parties for health care services is complex, expensive, and inefficient. Physicians end up using nearly 12 percent of their net patient service revenue to cover the costs of excessive administrative complexity. A single transparent set of payment rules for multiple payers, a single claim form, and standard rules of submission, among other innovations, would reduce the burden on the billing offices of physician organizations. On a national scale, our hypothetical modeling of these changes would translate into $7 billion of savings annually for physician and clinical services.

Wednesday, April 21, 2010

The Council of Medical Specialty Societies (CMSS) today announced the release of the CMSS Code for Interactions with Companies. The code provides detailed guidance to medical specialty societies on appropriate interactions with for-profit companies in the health care sector. The voluntary code is designed to ensure that societies’ interactions with companies are independent and transparent, and advance medical care for the benefit of patients and populations. CMSS represents 32 leading medical professional societies, with a collective membership of more than 650,000 U.S. physicians.

Click here to access the press release. Click here to access the code.

Monday, April 12, 2010

Check out an article whose lead author is Dennis Quaid, yep, you read it correctly, the actor teamed with some health care professionals to write "Story Power: The Secret Weapon" which was published in the March issue of the Journal of Patient Safety. As you might recall Quaid's twins were overdosed with heparin but survived this medical error. Click here to read this important article (free full text).

Thursday, April 01, 2010

Pfizer, the world’s largest drug maker, said Wednesday that it paid about $20 million to 4,500 doctors and other medical professionals for consulting and speaking on its behalf in the last six months of 2009, its first public accounting of payments to the people who decide which drugs to recommend.

Pfizer also paid $15.3 million to 250 academic medical centers and other research groups for clinical trials in the same period.

While other pharmaceutical companies have disclosed payments to doctors, Pfizer is the first to disclose payments for the clinical trials.

Saturday, March 27, 2010

From the New York Times article "Doctors Offer Thoughts on Cutting Health Care Costs":

How can the country reduce health care costs while not compromising quality?

During the health care debate, government officials, insurers, drug companies and medical associations all weighed in with their opinions. But what about the people who receive so much of our out-of-pocket health care payments: the doctors on the medical front lines? What do they think the country — in other words, you and me — should do to help moderate costs?

Wednesday, March 24, 2010

Texas Tech University's medical school will soon become the first in the U.S. to offer aspiring family doctors a three-year degree at half the cost of a traditional four-year path, university officials said.

The program, which begins this fall, is aimed at addressing a national shortage of family physicians. One study estimates the country will need about 39,000 more family doctors by 2020.

The Physician Payment Sunshine provisions were included in the Patient Protection and Affordable Care Act of 2009 (H.R. 3590, section 6002) which was signed into law on March 23, 2010.
Are gifts and payments limited?
The law requires public disclosure, but does not limit financial relationships.

Who must report? How often?
All U.S. manufacturers (and other entities under common ownership) of drug, device, biologics, and medical supplies covered under Medicare, Medicaid, or SCHIP must report payments on an annual basis to the department of Health and Human Services, which will post the information on a public website. The Secretary of Health and Human Services is further required to submit annual summary reports to Congress, as well as annual reports to each state.
What sort of payments count?
The health care reform law requires disclosure of payments whether cash or in-kind transfers to all covered recipients including: compensation; food, entertainment or gifts; travel; consulting fees; honoraria; research funding or grants; education or conference funding; stocks or stock options; ownership or investment interest; royalties or licenses; charitable contributions; and any other transfer of value as described by the secretary.

Monday, March 22, 2010

The Stanford University School of Medicine plans on Monday to introduce rules that would prohibit its volunteer teaching staff — called adjunct faculty — from giving paid speeches drafted by the makers of drugs or medical devices.

Stanford already has one of the most comprehensive policies in the country governing the interactions between academic faculty and the medical industry. The policy, enacted in 2006, is intended to limit potential industry influence on day-to-day clinical practice and medical education, according to a Stanford press release.

The policy prohibits faculty members from participating in industry speakers’ bureaus in which drug and medical device makers pay a physician to give company-prepared speeches to doctors about company medical products. It also prohibits Stanford faculty members from accepting free gifts, including drug samples for patients.

And as of Monday, the 660 community physicians who volunteer their time to teach at Stanford will also have to abide by the same policy — or give up their Stanford titles.

Saturday, March 20, 2010

Clostridium difficile infections (CDIs) are quickly becoming a significant issue in healthcare based upon recent studies. Preliminary data collected from nursing homes and highlighted in a Supplementary Pennsylvania Patient Safety Advisory shows that almost 40 percent of gastrointestinal infections reported are CDIs.

"Our first look at infection data submitted from Pennsylvania nursing homes confirms what prior studies have found in hospitals -- C. diff infections are a real problem in healthcare institutions," Mike Doering, executive director of the Pennsylvania Patient Safety Authority said. "Elderly patients are particularly at risk because of their age and their use of hospitals and nursing homes where the infection can spread more easily."

As one superbug seems to be fading as a threat in hospitals, another is on the rise, a new study suggests.

A dangerous, drug-resistant staph infection called MRSA is often seen as the biggest germ threat to patients in hospitals and other health care facilities. But infections from Clostridium difficile - known as C-diff - are surpassing MRSA infections, the study of 28 hospitals in the Southeast found.

Friday, March 12, 2010

The Healthcare Management Council, Inc. has released news that a 200-bed hospital can save up to $2 million a year by eliminating HACs. From their news release:

Using federal Agency for Healthcare Research and Quality (AHRQ) indicators, HMC has analyzed the performance of hundreds of facilities ranging in size from 75 beds to over 800 beds. Now in a recent study, HMC identified the top Hospital Acquired Conditions (HACs) and established how much extra care each of these HACs requires. HACs have resulted in nonpayment from Medicare and Medicaid, and in the future, private insurers will likely stop covering HAC-related costs, as well.

Tuesday, March 09, 2010

As presently organized, Medicare violates every rule of an efficient enterprise. It has no CEO with powers of a kind expected in business. Its stakeholders, the Congress, have a right to interfere with its day-to-day operation. It has no annual budget or the fiscal discipline that imposes. It can set few limits to its expenditures, even to the present point of running an annual deficit. And it underpays its administrators in comparison with those with like responsibilities in the private sector – just as it has too few administrators in the first place.

The National Institutes of Health, the world’s preeminent biomedical research institution, exemplifies everything Medicare lacks. It has a director with strong authority, an annual and tightly managed budget, lay advisory groups, and a good relationship with Congress, one marked by deference on the latter’s part and considerable discretion in setting its priorities. Atul Gawande among others has celebrated the quality and efficiency of the Mayo Clinic, the Geisinger Health System, and Intermountain. They are all private but share a similar budget and administrative structure akin to that of the NIH—everything Medicare lacks.

From the NEJM article by Robert Mechanic, M.B.A., and Stuart Altman, Ph.D.:

One approach to accelerating delivery-system change would be comprehensive reform of Medicare’s provider-payment system. Such reform was proposed early in last year’s debate but was eliminated as legislators began to understand that comprehensive payment reform could be highly disruptive for hospitals and physicians who are unprepared to rapidly modify their clinical operations. Instead, legislation passed by both the House and the Senate directed the Centers for Medicare and Medicaid Services (CMS) to implement a series of voluntary pilot programs, including a national payment-bundling demonstration and a program allowing accountable care organizations that successfully control growth in per-beneficiary spending while meeting quality goals to share in Medicare’s savings.

Congressional reform proposals also include a new Center for Medicare and Medicaid Innovation (CMI) intended to facilitate beneficial delivery-system changes.

Thursday, March 04, 2010

Q. You write that doctors have an ethical responsibility to advocate health care reform. Why?

A. Doctors have two responsibilities. First, they have a moral duty as an individual advocate. A doctor has a responsibility to his or her individual patients to make them healthier and to help them live longer.

But doctors have a second moral duty: they have an obligation to the general public to be prudent stewards of scarce resources. Doctors only get about 10 percent of health care costs in their pockets, but they control about 80 percent. That isn’t our money — it’s someone else’s — and the public has entrusted us to spend it as wisely as possible.

Wednesday, March 03, 2010

The AAFP is supporting two proposals recently made by the Accreditation Council for Continuing Medical Education, or ACCME. One would modify the ACCME's complaints and inquiries process with the aim of balancing transparency in the CME enterprise with CME providers' confidentiality. The other would acknowledge that CME should facilitate changes in knowledge, competence, performance and/or patient outcomes.

Friday, February 26, 2010

and includes information on the Program & Activity Reporting System (PARS), a step-by-step tutorial on Learning from Teaching, a brief survey to solicit input on ACCME Education and Training web pages, plus more! Click here to access.

Saturday, February 20, 2010

Recently, it was brought to my attention that WebMD Health Corporation (WebMD) is running a depression screening advertisement on television. This advertisement encourages the viewer to take a screening test sponsored by Eli Lilly on WebMDs website. I am concerned about the independence between WebMD and industry since many people access WebMD seeing it as an independent, objective medical resource.

Click here to access the letter which is posted online. Hat tip to Pharmalot.

Saturday, February 13, 2010

Just in time for Valentine's Day, researchers have reported that chocolate may keep sweethearts safe from stroke.

To reach that conclusion, Sarah Sahib, BScCA, of McMaster University in Hamilton, Ontario, and colleagues reviewed three studies, two of which showed that chocolate significantly reduced stroke risk, likely because of its flavonoid content.

Tuesday, February 09, 2010

The University of Utah School of Medicine CME folks had an interesting poster at the recent Alliance conference in New Orleans...they've set up an online system for their physicians whereby the physicians can search the Internet and get CME credit for doing so. And, apparently, they are willing to share their low-cost online program with others! Click here to access more information on this jewel of a find! Also be certain to check out the slides from their presentations at the Alliance conference.

The newsletter contains a number of good articles (at least read the lead article) as well as a link to the 2010 edition of State Medical Licensure Requirements. Click here to access the newsletter. If you just want the updated State Medical Licensure Requirements, click here.

Monday, January 18, 2010

The British National Institute for Health and Clinical Excellence has guidelines on medication adherence, which we all know is a problem. Click here to access the quick reference guide for these guidelines.

Monday, January 11, 2010

Stanford University on Monday will announce plans to develop new continuing education programs for doctors that will be devoid of the drug industry influence that has often permeated such courses....Dr. Philip Pizzo, dean of the Stanford medical school, says Pfizer will have no say on how the three-year grant will be spent. The university plans to set up unbiased programs of postgraduate education on the Stanford campus rather than the industry-selected topics of the past that have been presented to rooms full of doctors at hotels and resorts.

Monday, January 04, 2010

Don't know how I missed this, but here it is now. From Senator Grassley's early December press release:

Senator Grassley has asked 33 medical groups for information about the financial backing they get from the pharmaceutical, medical device and insurance industries.

“These organizations have a lot of influence over public policy, and people rely on their leadership. There’s a strong case for disclosure and the accountability that results,” Grassley said.

Grassley said his inquiry follows a review of industry support for the National Alliance on Mental Illness, where he questioned the organization’s national office and state chapters. The Alliance subsequently adopted a new policy of publicly releasing industry support over $5,000. “It’d be good for the system if other organizations would follow NAMI’s lead in this area,” Grassley said.